Aggrived policyholders may reach out to Insurance Ombudsman in different locations either themselves or through legal heirs, nominee or assignee, make a written complaint to the Insurance Ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential address or place of residence of the complainant is located.
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You may approach the Ombudsman if: you have first approached the insurance company with the complaint and they have rejected it; not resolved it to your satisfaction or not responded to it at all for 30 days. The insurance ombudsman can be reached out for any policy you have taken in your capacity as an individual and the value of the claim including expenses claimed is not above Rs 30 lakhs.
You can complain to the Ombudsman in the following cases:
-Partial or total repudiation of claims by the Life insurer, General insurer or Health insurer.
-Misrepresentation of policy terms and conditions at any time in the policy document or policy contract.
– Legal construction of insurance policies in so far as the dispute relates to claim
– Policy servicing related grievances against insurers and their agents and intermediaries
– Issuance of life insurance policy, general insurance policy including health insurance policy which is not in conformity with the proposal form submitted by the proposer.